DESCRIPTION: Aphasia is a language impairment that can result from damage to the brain after stroke. It impairs a person's ability to read, write, speak, and understand. Aphasia is usually treated through language?based treatments. While effective, there is substantial variability in the outcomes of these treatments. Other factors, such as long?term stress, may influence the success of treatment. Research has shown that chronic stress may change how the brain works; specifically, it may change how well the brain can remember and learn. Aphasia treatments, like other types of rehabilitation, require learning and memory. If veterans and others with aphasia are chronically stressed, they may not be able to improve with treatment. In the proposed study, the candidate will develop a measurement of chronic stress for people with aphasia. This will be accomplished by modifying a questionnaire about chronic stress, called the Perceived Stress Scale (PSS; Cohen & Williamson, 1988), so it may be understood and used by people with aphasia, or people with other communication difficulties. The questionnaire will be systematically modified with the input of aphasia researchers and clinicians, outcomes measurement experts, people with aphasia, and their caregivers. Then, the modified PSS will be validated with 75 people with aphasia. These research participants will also provide a small sample of scalp hair, used to measure a stress hormone called cortisol, and provide biological information about the level of stress the participant has experienced over the last several months. Responses from the modified PSS, the amount of cortisol in the hair sample, and responses from a few select questionnaires about stress, psychological resilience, depression, and anxiety will be analyzed to assess the validity of the modified PSS, and understand how stress and other self-reported psychological factors may be related for this population. Once this study is complete, the modified PSS will be used in future research to a) determine if chronic stress is a barrier to rehabilitation of aphasia and other cognitive?linguistic impairments, and ) develop treatments for chronic stress to ensure greater treatment success for veterans and others with aphasia, and other types of brain injuries. Many veterans and others with acquired brain injuries are chronically stressed. Chronic stress may limit a person's neurological capacity to learn, a requirement for effective speech, language and other cognitive treatments. Veterans with brain injuries who are chronically stressed may not be able to benefit from rehabilitation, wasting the time, efforts, and financial resources of patients, families, healthcare providers and related organizations, like the VA. The proposed study will develop a measure of chronic stress to understand this factor and its impact on rehabilitation success. The ultimate goal of this research program is to find ways to minimize chronic stress and maximize treatment outcomes for veterans.